PEDIATRICS Section I: Skull and Scalp Flashcards
1
Q
premature fusion of one or several of the cranial sutures.
A
Craniosynostosis
2
Q
Besides looking like a gremlin (or a cone- headed extraterrestrial forced to live as a typical suburban human), kids with Craniosynostosis can also have these
A
increased intracranial pressure, visual impairment, and deafness.
3
Q
Craniosynostosis:
Frontal
A
Metopic
4
Q
Craniosynostosis:
Frontal and parietal
A
Coronal
5
Q
Craniosynostosis:
Parietal + Occitpital
A
Lambdoid
6
Q
Craniosynostosis:
Parietal
A
Sagittal
7
Q
Craniosynostosis:
Front to back
A
Frontal
8
Q
Craniosynostosis:
Lateral to medial
A
Coronal adn Lambdoid
9
Q
Craniosynostosis:
Sagittal
A
Back to front
10
Q
Craniosynostosis order of Fusion
A
First (2-3 monhts: Metopic
Second: Coronal
Third: Lambdoid
Fourth: Sagittal
11
Q
Normal Suture vs Early closure apperance
A
Normal: Serrated (sawtooth)
Early Closure: More dense and sharp, eventually will disappear completely.
12
Q
What are idiopathic types of craniosynostosis?
A
Sagittal and UNIlateral craniosynostosis
13
Q
Eyes are close together (hypotelorism)
A
Metopic Synostosis “Trigonocephaly”
14
Q
Ethmoid sinuses underdeveloped
A
Metopic Synostosis “Trigonocephaly”
15
Q
“Quizzical Eye” appearance
A
Metopic Synostosis “Trigonocephaly”
16
Q
Medial part o f the orbit slants up
A
Metopic Synostosis “Trigonocephaly”
17
Q
Single suture synostosis most frequently associated with cognitive disorders (growth restriction of the frontal lobes)
A
Metopic Synostosis “Trigonocephaly”
18
Q
Diagnosis
A
“Harlequin Eye” in UNILATERAL Coronal Synostisis (Brachycephaly)
19
Q
What is the common subtype of Coronal Synostosis?
A
Unilateral Subtype
20
Q
“Frontal Bossing”
A
Unilateral Coronaral Synostosis (Brachycephaly)
21
Q
Tall Cranium
A
Lambdoid (turricephaly)
22
Q
Least common craniosynostosis
A
Lambdoid (Turricephaly)
23
Q
Most common Craniosynostosis
A
Sagittal (Scaphocephaly/Doichocephaly)
24
Q
Long, Narrow Head.
Looks like an upside-down boat.
Usually the kids have a normal IQ
Usually the kids do NOT have hydrocephalus
A
Sagittal (Sagittal (Scaphocephaly/Doichocephaly)
25
SAgittal craniosynostosis
26
Associated with Marfan's
Sagittal (Scaphocephaly/Doichocephaly)
27
Also referred to as Kleeblattschadel for the purpose of fucking with you
Clover Leaf Skull Syndrome
28
enlargement of the head with a trilobed configuration, resembling a three-leaved clover.
Clover Leaf Skull Syndrome
29
Clover Leaf Skull Syndrome results from premature synostotis of what sutures?
Coronal and Lambdoid (Most common) sutrues
30
What is the most common finding of Clover Leaf Skull Syndrome?
Hydrocephalus
31
Clover Leaf Skull Syndrome is associated with what disease?
Thanatophoric dysplasia
Apert syndrome (severe)
Crouzon syndrome (severe)
32
Most associated Syndromes of craniosynostosis?
Apert’s and Crouzon’s.
33
Brachycephaly (usually)
Fused Fingers (syndactyly) - “sock hand” —typically symmetrically fused hands and feet
Apert's syndrome
34
Brachycephaly (usually)
1st Arch structures (maxilla and mandible hypoplasia).
Hydrocephalus (more than Apert’s)
Chiari I malformations 3: ~70% of cases
Associated with patent ductus arteriosus and aortic coarctation.
Short central long bones (humerus, femur) - “rhizomelia’'
Crouzon's
35
What are the 7 C's in Crouzon's?
Coronal sutures fused,
Can’t Chew (1st arch structures),
Chiari I, Coarctation,
hydroCephalus,
Central bones short (rhizomelia).
Crazy eyes (exopthalmos).
36
If you see them along the more anterior skull then you should think about what?
"Copper beaten skull" from the increased intracranial pressure.
37
Diagnosis?
Give conditions that can cause this.
Copper beaten skull
Classic exampes:
Craniosynostosis
Obstructive hydrocephalus
38
Diagnosis?
Luckenschadel - “Lacunar"
39
Oval, round, and finger shaped defects (craters) within the inner surface of the skull. Most prominent in parietal bones.
Luckenschadel - “Lacunar"
40
How is Luckenschadel different from Copper beaten skull?
Different than Copper Beaten in that:
(A) They aren’t gyriform.
(B) They aren’t related to increased ICP.
(C) They are usually present at birth.
41
Skull markings associated with hydrocephalus
Copper beaten skull
42
What's the cause of Luckenshadel?
Defective bone matrix
43
Luckenshadel is associated with what conditions?
Classic Association:
* Cliiari II malformation /Neural Tube Defects.
44
What are the common conditions presenting with Lytic Skull lesions?
LCH, Infection, Mets, Epidermoid Cysts, Leptomeningeal Cysts,
LCH and Leptomeningeal cysts are common
45
Too many fucking dendritic cells - with local invasion. It is a sorta pseudo mahgnancy thing.
LCH (Langerhans Cell Histiocytosis)
46
beveled hole in the skull.
LCH (Langerhans Cell Histiocytosis)
47
Diagnosis
LCH (Langerhans Cell Histiocytosis)
48
What is the most common bone invovled in LCH
Skull
49
Describe the LCH (Langerhans Cell Histiocytosis) bone lesion
Pure lytic (No sclerotic border)
Beveled look favirs the inner table
50
What is this?
Button sequestrum
51
If you see lytic skull lesions in a kid with neuroblastoma, what do you thick about?
Metastasis
52
Diagnosis?
Cause?
These paired, mostly round, defects in the parietal bones represent benign congenital defects.
The underlying cause is a delayed or incomplete ossification in the underlying parietal bones.
53
Diagnosis?
Describe
Wormian bones
Extra squiggles around the lambdoid sutures. “Intrasutural Bones” they call them.
54
When you say, Wormian bones thick of?
<10 = Idiopathic
> 10 = First think Osteogenesis Imperfecta
> 10 + Absent Clavicle = Cleidocranial
55
Differentials of Wormian bones?
PORK CHOP
Pyknodysostosis
Osteogenesis Imperfecta
Rickets
Kinky Hair Syndrome(Menke s /Fucked Copper Metabolism)
Cleidocranial Dysostosis
Hypothyroidism / Hypophosphatasia
O ne too many 21st chromosomes (Downs)
Primary Acro-osteolysis (Hajdu-Cheney)
56
These conditions occure from the congenital misplacement of cells from the scalp into the bony calvarium.
Dermoid / Epidermoid of the Skull
57
Diagnosis?
SKull epidermoid
58
Most common location of skull epidermoid?
Parietal Region is Most Common
( “behind the ears ”)
59
Most common location of skull Dermoid?
Tend to be midline. The skin ones tend to be around the orbits.
60
Skull dermoid is associated with what condition when midline?
Ecephaloceles
61
CT/MRI appearance of Skull Epidermoid vs Dermoid
Epidermoid:
CT: CSF
MRI: T1 Variable T2 Bright - Enhancment
Dermoid:
CT: Heterogeneous/ + Calcs
MRI: T1/T2 Bright + Wall enhancment
62
This is a fracture along / involving the suture.
DIastatic Fracture
63
Most common location of diastatic fracture
Lambdoid
64
How does one know there is traumatic injury to a suture ?
lassically, it will widen. This is most likely to be shown in the axial or coronal plane so you can appreciate the asymmetry ( > 1 mm asymmetry relative to the other side).
65
This is a fracture with inward displacement of the bone.
Depressed fracture
66
This is actually another subtype of depressed fracture but is unique in that it is a greenstick or “buckle” type of fracture.
Pingpong fracture
67
Diagnsosis?
Pingpong fracture
68
A fracture that typically has a favorable / benign clinical outcome (depressed fractures have high morbidity).
Ping Pong
69
occur in the setting of birth trauma (Mom’s pelvic bones +/- forceps).
Ping Pong
70
Indication for surgery in Depressed Fx
> 5 mm depression of fragments
Epdirual bleed
Superinfection
Form
function
71
"Growing Skull fracture"
Leptomeningeal Cyst
72
Diagnosis?
Leptomeningeal Cyst
73
PAthogenesis of Leptomenigeal Cyst
Step 1; You fracture your noggin, AND tear the underlying dura.
Step 2: Leptomeninges herniate through the tom dura intoo the fracture site.
Step 3: Over time (a few months) CSF pulsations progressively widen the fracture site and prohibit normal healing.
Step 4: You know you shouldn’t, but you just can’t resist the urge to poke your own brain through the now cavernous cranial defect.
Initial ^ Film
Step 5: The poking triggers a powerful hallucinogenic experience. You have a telepathic conversation with a room filled with self-transforming elf machines.
You are overwhelmed with tremendous curiosity about exactly
what/who they are, and what they might be trying to show you.
Step 6: You develop epilepsy from poking your brain too much. Or was it not enough? - you can’t remember
74
A rare disorder that can be shown as a focal skull defect with an associated vascular malformation.
Sinus Pericranii
75
Diagnosis?
PAthology?
Sinus Pericranii
The underlying pathology is a low flow vascular malformation - which is a communication between a dural venous sinus (usually the superior sagittal) and an extra cranial venous structure via the emissary veins.
76
Diagnosis
Sinus Pericranii
77
Has a stronger associattion with Non-accidental Trauma
Subdural or Epidural?
Subdural
78
REtroclival HEmatoma:
Below the Tectorial membrane
Epidural Hematoma
79
REtroclival HEmatoma:
Above the Tectorial membrane
Subdural Hematoma
80
Chronic Subdural (CSF Density) vs Prominent CSF spaces:
Medial Displacement of Bridging Vein
Chronic Subdural (CSF Density)
81
Chronic Subdural (CSF Density) vs Prominent CSF spaces:
Cortical veins are adjacent to the innder table
Prominent CSF spaces:
82
Chronic Subdural (CSF Density) vs Prominent CSF spaces:
Usually Unilateral
Chronic Subdural
